Friday, May 14, 2010

I've tried several medications for Mrs. Hedhurtz, including Fukitol, Painbegone, Nomigraine, Acefalgia, Gonehert, and Nopayn, all without success.

I've done MRI's, MRA's, and a spinal tap on her. I sent her to an ophthalmologist.

I was frustrated. She was more frustrated. I wasn't having a lot of success helping her. And she seems like a nice lady.

So, since you advertise yourself as a neurologist who specializes in treating difficult headaches, and cite your 2 years of headache subspecialty fellowship training, I decided to refer her to you. You opened up shop near me last month, so I thought I'd give you a chance to earn my referral business. Your marketing person dropped off some cards here 2 weeks ago.

And yesterday I got your faxed note about her.

At the beginning of your note it says that "I've reviewed Dr. Grumpee's notes and tests in detail." That was your second lie (your first lie is in calling yourself a headache specialist, or even a doctor). I also loved the fact that you spelled my name wrong.

Your note ends with the following, which I've paraphrased.

"Impression: Mrs. Hedhurtz suffers from chronic headaches. She's previously failed trials of Fukitol, Painbegone, Nomigraine, Acefalgia, Gonehert, and Nopayn.I suggest she be referred to an ophthalmologist. A spinal tap should also be considered.

For future treatment, I suggest she be started on a medication that she hasn't previously tried before.I've referred her back to Dr. Grumpee's care to follow my recommendations.

Yours truly,

I. M. Worthless, M.D."

Thank you SO fucking much for your helpful advice. I'd normally say "thanks for nothing", but what you've done doesn't even amount to that much.

As my late grandfather would have said, "this is the second time I've sent you a patient. First and last."

I have severe anemia. I have since I was young. *EVERY* new doctor thinks s/he's magically discovered the cause -- I have Cancer! I have Bleeding from the Bleed-o-organ! I have Fad-Disease-of-the-Month!

I can point out that in my charts it shows a history of anemia back to age 11. I can pull out copies of blood tests [which they have!] going back 5 years - if only I still had ones from when I was 11. Yet everyone becomes convinced that I have $WHATEVER and I'm going to die tomorrow if we don't have that taken care of!

The whole "we have to fix this now now now" has calmed down a lot now that I don't have insurance, which is more amusing. But, really, why do I have records if nobody is going to bother reading it?

The sad thing is that good neurologists are pulled into the cesspool with the bad. Locally, the final result was some very good neurologists bailed out of self defense, which left some really bad choices for local referral. My wife, and I, were rewarded with a horrendous experience, that can only be described as the ignorant being led by the ingorant.

You live and you learn and thank you Dr. Grumpy for sharing how hard being a good doctor really is, especially when you see how the odds are stacked.

OMG! Headache Lady is me! (Minus the spinal tap.) And the doctor you referred to is my neurologist! (Except he washed his hands of me and sent me back to my GP to be treated with pain meds forever and a day.) Next month, the headache clinic. Pray for me, Dr. Grumpy!

I've never responded before, but love your blog. Since you sound stuck with this pt, have you considered TMJ? I was having constant headaches for 2 years. I saw my internist, then 3 different neurologists (one a headache specialist, but a much better one than the one you wrote about) and no one could figure out what was wrong with me. They did every test you can think of and I tried numerous meds with no relief at all. I got a massage one day, and the massage therapist thought I had mild TMJ. I began looking up the symptoms of TMJ, and there were all my symptoms. I never had jaw pain so no one had ever considered that possibility. I saw a PT for exercises and got a mouthpiece to wear at nights. I feel 1000x better now. You might have already thought about this, but I thought I'd reply just in case it could help.

I was gonna post earlier and mention TMJ and even wisdom tooth issues, but decided against it because I'm a big ole chicken. But we are taught in Hygiene school that many headache issues can result from TMJ and impacted wisdom teeth. I regularly ask patients in my own clinic if they have frequent headaches as I'm assessing their TMJ and they are asked on their med hx if they have a history of headaches. As soon as I read this post I wondered if maybe this patient had seen a dentist and if she still had her wisdoms in or if she had been having TMJ pain.

Inevitably hormones, agitation, or sinus symptoms or a combination of several or all bring on my headaches. The best 'cure' for me is two sniffs of fluticasone (each nostril), a couple whiffs of oxymetazoline, 325 - 500 mg acetaminophen (or placebo), a cup of tea (black pekoe), and going to bed in a quiet, darkened, cool room for 8 hours or so. It helps that whatever anxiety I'm facing e.g. term paper or presentation due, squalling children, or mortgage payment, has been rectified before said 'nap'.

::bangs head repeatedly on desk:: Now I know what my Good Docs are seeing on the Other Side when they get reports from the Evile Idjet Docs. ::rolls eyes:: I've been a chronic pain patient for over 20 years & have depression issues as well (duh, they run on the same neural pathways!). Meds? We got tons of stinking meds!

I can't begin to count the number of times I've had to say, "No, I've already tried/taken/done xyz. I can understand not taking a good medical history in baby docs (although it still irks me), but someone who has been practicing for years?? A specialist?? Sheesh!!

Thanks for this post! It makes me happy that there are doctors like you who are willing to be frusterated with your frusterated patient, and to stay open to new options. I now see a migraine specialist, and I must say the reason that he is the *specialist* I think is that he doesn't give up on me even if I'm having a bad period, and that he's willing to be thinking of new things (you know since I've tried and failed or just had bad reactions to most preventives more than once unfortunately). That said, I take plavix for migraines, and oddly it really helps. Weird I know, but hey I'm not looking any gift horses in the mouth, or whatever.

I for one, don't know about anyone else, immediately think sketchy if a doc. advertises self. I figure, worth of mouth by informed patients and other HCPs are the best marketing/advertisement of a good one.

Reading that note made me angry. It sounded like my former neurosurgeon's notes who dismissed me during my visit because my most concerning tumor wasn't CNS enough.

He arely looked through my scans.... yet, when I got copies of records from his office, his notes were full of regurgitated radiology reports pretending to be his own reads(dude, I KNOW you didn't really read my scans, I watched you not read) He documented it as a level 3 visit, no doubt Dr. headache-specialist coded her visit as a high-complexity visit...

Though, while reading my NS's notes, I did laugh at malignant degeneration transcribed as moving and degeneration. I wish the tumor would move away!

@Lorelei - oddly enough, it was adding magnesium (first 250 mg and then 500 mg) with a combo of Topomax that brought my migraines under control. I have maybe one or two a year now. I can live with that!! But it just goes to show how amazing the human body is. I live for the day when we can input a drop of blood into machine and have it pop out the correct medication & dosage. (I wonder if that will come before nanorepair or not.)

Like Mrs. Hedhurtz, I've tried every medicine under the sun and nadda. So my neurologist sent me to Chicago (several states away might I add) to see a big name headache group up there who basically did exactly what Dr. Worthless did for your patient. $600 in transportation well spent!Oh and I love how every person I meet is an expert on headaches! Well Gosh I'm sure if I had just known to take Excedrin before I gave myself those three shots that didn't work I wouldn't have ended up in the ER! Thanks a bunch!

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

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